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The public has been wearing masks for over a year now. It has become a part of our day to day lives. Now, with more and more individuals being vaccinated, restrictions are being lifted. The question on the minds of many is if it is necessary to wear masks outdoors? Especially when not surrounded by people. The fact stays that the majority of viral transmission doesn’t happen outside. The Journal of Infectious Diseases reported in November of 2020 that the odds of any viral transmission is 18.7 times more likely to happen indoors, rather than out. The review also revealed that less than 10% of COVID-19 infections studied were transmitted indoors. Other professors believe that the actual number of instances of outdoor transmission was even lower than 10%. The US Centers for Disease Control and Prevention have written on their website that masks are generally not necessary outside, especially when you’re six feet away from others, or are with those from your household. However, there is nothing on the CDC’s website that specifies about the role vaccinated individuals play. Director of the CDC, Dr. Rochelle Walensky spoke on the topic to NBC’s Today Show. “We’ll be looking at the outdoor masking question, but also in the context of the fact that we still have people who are dying of COVID-19.” It appears that the answer to the question of whether one should or should not wear a mask outdoors is not always explained in definite terms. For example, it is based on various factors such as vaccination status, percentage of positive cases and the transmission rate within that particular community. These should always be considered before being outdoors, unmasked. Of course being vaccinated is first on the list for avoiding infection. Lindsey Marr, who is an expert on the airborne transmission of viruses at Virginia Tech, spoke to CNN about the topic. “If you’re vaccinated and not in a vulnerable category, it’s probably fine not to wear a mask outdoors.” Marr also tells CNN that masks should be worn in situations when people are close together, like in a bar or small crowd. “If you’re unvaccinated and constantly passing by people close enough that you can reach out and touch them, then you should wear a mask.” Many experts believe that masking will soon transition to being an indoors only expectation. Some states have already made the transition. Other states such as Texas, Alabama, and Florida have lifted their statewide mask mandates, and even more states are now beginning to loosen pandemic guidelines. The CDC still repeats that a mask is not a replacement for social distancing. Everyone should still wear a mask, and stay six feet apart from others. Masks should always cover the nose and mouth, fitting tight against the face without any gaps. Sadly, until this pandemic is over, masks will probably continue to be a full time requirement, both indoors and outdoors in most states and counties. However, as the percentage of vaccinated individuals increase, social isolation will become less and less of a necessity.
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In the summer of 2020, protests and riots erupted nationwide after police fatally shot an unarmed black man named George Floyd. In Portland, Oregon, these justice demonstrations have often led to law enforcement expelling tear gas on the crowds of people. Initially, female protestors were convinced that regularly being exposed to this chemical interfered with their menstrual cycles. In the nation’s first peer-reviewed study, it’s been shown that these statements may hold credence. The study was done out of Portland’s Kaiser Permanente Center for Health Research and was published in April of this year in “BMC Public Health,” a medical journal. Researchers looked at health issues experienced by women and men after being exposed to the chemicals inside tear gas. They were exposed to the tear gas during the aforementioned justice demonstrations that took place in Portland from July 30th to August 20th. For the study, 2,257 adults were surveyed. The majority were exposed to the tear gas during a protest, but around 150 of them were exposed in their homes or other areas nearby. The survey was online, and asked about physical and psychological health issues. Some example questions included if the participants had looked for health care afterwards or experienced menstrual changes. A large majority of menstruating respondents went on to report having irregular periods after being exposed to tear gas. Specifically over half, or 54.5%, reported that their menstruation cycle was disturbed after their encounter with the chemical. The most common issues divulged after the survey included increased menstrual cramping at 36.6%, unusual spotting at 27.8%, increased bleeding during menstruation at 23.6%, and longer periods than expected at 18.9%. Some other impacts that were reported during the survey include tenderness of the breast or chest, increased blood clots, blood color change, and the complete absence of a period all together. The study went on to state that many survey respondents saw a change in their menstrual cycle. In the peer-reviewed study, respondents claimed menstruation began “days or weeks earlier or later and lasted longer, compared to their typical cycle.” Notably however, Ted Wheeler, who is the mayor of Portland, did ban police from using CS gas, which is an often used type of gas. This has been applied in most situations, starting back in September. The study’s lead author also stated that this report leaves many questions unanswered. This includes the question of whether chemicals found in tear gas can impact the endocrine system, and if so, which chemicals are considered responsible. It is possibly a reaction from a combination of chemicals, as well. Lead author, Britta Torgrimson-Ojerio has also said, “We can’t say anything definitive. Other than that this is widespread and widely reported.” She also brought to light that a protest is scientifically not considered a controlled environment, whatsoever. Other influencing factors could have skewed findings. The study acknowledged this, saying that the stress found in these environments could have very well been the reason behind these irregular periods. Cortisol is a hormone that the body releases during stressful situations, and has been proven to disrupt regular menstrual cycles. Other experienced symptoms that were reported within the survey could be due to stress, and therefore increased cortisol levels. Almost half of the survey-takers reported lung and chest issues. While, nearly one third reported gastrointestinal issues mere days after their exposure to tear gas. The study also discovered more than half of the survey respondents received healthcare services, or planned to receive healthcare services. Oregon Public Broadcasting (OPB) published statements on their website that were made by the lead study author, Torgrimson-Ojerio added to this by saying “We have no reason to believe that stress impacted these findings more than any other.” On this same article, OPB mentions a 25-year-old named Theo Blackman who believes that a summer of regular exposure to tear gas is the cause behind their period coming to a halt. Theo is not on hormones, isn’t pregnant and hasn’t reported any major life changes. However, in the last 10 months or so, they haven’t experienced spotting, cramping, or a period of any sort. Theo is quoted as saying “I really hope people are actually paying attention to what this is going to be doing. This is a lifelong repercussion, possibly.” There is no way of knowing whether these survey results are due to tear gas or stress, without further research and testing being done. This does highlight that more research does need to be done on the subject, and that tear gas may be more harmful than originally thought. If any individual is planning to protest or be around any sort of political demonstration, they would be wise to be safe and wear protective gear, if possible. At least until more information is uncovered.
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the future is telehealth...   https://www.nytimes.com/2020/11/23/upshot/pandemic-telemedicine-emergency-care.html?smid=url-share
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The Mental and physical health deterioration caused by missed doctor's appointments during the covid-10 pandemic

 During a massive portion of 2020, especially during the beginning of  the pandemic, many businesses closed down temporarily due to COVID-19  restrictions. Those that were able to stay open, the essential businesses and  certain doctor’s offices and such, had to attempt to navigate this bizarre new  world. For some offices, they begun care at an emergency only basis. People  that had appointments were canceled. Even as restrictions somewhat loosened and appointments were able to be rescheduled, many people felt uncomfortable to do so, due to the coronavirus and the valid fears that surround it.    A new report titled “Delayed and Forgone Health Care for Non-elderly  Adults during the COVID-19 Pandemic,” has been recently published on the  Urban Institute’s website on February 16th, 2021. They used data from over  4000 adults aged 18 to 64, collected by their own September 2020  Coronavirus Tracking Survey. While reviewing the data compiled by the  survey, researchers noticed around one-third, or 36% of non-elderly adults  delayed health care or did not get care because they were either concerned  about being exposed to the coronavirus, or because their health care  provider was offering limited services due to the pandemic.    Among those who did delay or completely miss a health care appointment, 32.6% revealed that the gap in care caused one or more of their health conditions to deteriorate, or restrict their ability to be productive  at work or other daily chores and activities. Researchers note the findings exemplify “the detrimental ripple effects of delaying or forgoing care on overall health, functioning, and well-being.”    The Urban Institute examined the data encompassing delayed or forgone care during the pandemic for nine different types of health care services and analyzed patterns by race/ethnicity, income and the presence of pre-existing physical and mental health conditions. The nine different areas of health care questioned in the survey concern delays in prescription drugs, general doctor and specialist visits, going to a hospital, preventive health screenings or medical tests, treatment or follow-up care, dental care, mental health care or counseling, treatment of counseling for alcohol or drug use, and other types of medical care.    They noticed that individuals with one or more chronic health problems  are more likely to have delayed or forgone care. The numerical difference  being 40.7% versus 26.4%. Those with a mental health condition were particularly susceptible. Dental care was the most common delayed area of  health care among respondents at 25.3%, followed by general doctor or specialist visits at 20.6% while preventive health screenings or medical tests stand third in line, at 15.5%.   African American adults were more likely than White or Hispanic/Latino adults to report having delayed or forgone care at 39.7%, with White adults at 34.3%, and Hispanic/Latino adults at 35.5%. Also, low income individuals were of higher likelihood to have forgone multiple types of care at 26.6%,  when compared to their high income counterparts at 20.3%.    Some doctors are already noticing the repercussions of these missed visits. Dr. Jacqueline W. Fincher, president of the American College of  Physicians tells Medscape about two patients of hers that missed  appointments during 2020. Both patients have long-term health issues.  When they each began care again in 2021, their laboratory tests revealed noticeable kidney deterioration. Fincher, who works as a general internal medicine physician in Georgia, shares that one of the patients “was in the hospital for three days and the other one was in for five days.”    According to Fincher, her office in particular vows to have been take charge when it comes to reminding patients with chronic diseases who have  missed follow-up appointments or have laboratory tests to reschedule. She  states they are also proactive as far as calling patients who may have run  out of medication. Dr. Fincher states that the majority of delays have been at  the fault of the patient postponing appointments. Her office has been open  during the entirety of the pandemic, and provides telehealth appointments,  as well as in-person visits that follow the CDC’s suggested safety  precautions.    One article published online on Frontiers in Psychology during September of 2020, similarly talks about the “devastating ripple effects of the COVID-19 crisis.” Written by Michaéla C. Schippers, she believes it to be “expected that hundreds of millions of people will die from hunger and postponed medical treatments.” However, there is no current data backing the numerical validity of her prediction, but there is research that seems to support her claims surrounding the possible negative effects the lockdown may have on an individual’s mental health, along with the dangers  surrounding delayed health care.    Schippers believes many of the negative psychological effects crafted  by the COVID-19 virus can be counteracted “by means of online life crafting  therapeutic writing interventions,” and various other coping methods. She explains that life crafting expressive writing can generate positive emotions,  be very self motivating, and ascribe new meaning to one’s life. It is the  practice of writing about one’s ideal life and goals, including plans to achieve  these goals. Schippers cites various sources to support her theory that these  sorts of writing exercises may be productive in improving well-being. Some  of the other positive coping strategies she mentions is healthy eating and  exercise, as well as social support.    She ends her article with several suggestions, one of which advocates  for the government to provide the public with more information about  effective coping methods. Schippers also states that her hope is that “the  negative side effects will, to some extent, be counteracted via smart  interventions and community care.”    As many are aware, chronic problems that are left on their own,  whether they be mental or physical, can often result in internal damage.  Many of the issues that have come from delayed and foregone appointments  due to the COVID-19 pandemic have not been studied yet. As experts  uncover and analyze further data surrounding patient outcomes, a better  picture of these negative repercussions can be formed. Regardless, this  teaches not to ignore or postpone healthcare appointments, whether they  are physical or mental, all are important. Medical facilities have many  procedures in place currently designed to protect themselves and the  general public from further transmitting coronavirus, and if possible in one’s  current situation, telehealth care services are highly recommended.
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Inflammatory Bowel Disorder and Newly Found Molecular Master Switch

Inflammatory bowel disorder, or IBD, is an umbrella term that is used to catalog disorders that involve chronic inflammation of the digestive tract. These include ulcerative colitis and Crohn’s disease. Both disorders are characterized by diarrhea, bleeding of the rectum, bloody stools, abdominal pain, cramping, fatigue and unintended weight loss. Both are largely debilitating and can even lead to fatal complications. A main difference between ulcerative colitis and Crohn’s disease is that the first disorder involves inflammation and ulcers along the large intestine’s lining and rectum. While Crohn’s disease also involves inflammation of the digestive tract’s lining, it can also involve deeper layers within the digestive tract. Exact causes of IBD are still unknown. Although theories have been formulated. Medical researchers believe one possible cause behind IBD is the immune system backfiring, and attacking the cells in the digestive tract instead of the intended foreign virus or bacteria. Some risk factors are thought to include family history, cigarette smoking, and non steroidal anti-inflammatory medications like Advil and Motrin IB. Some complications that can occur as a result of ulcerative colitis and Crohn’s disease include colon cancer, blood clots, malnutrition, anal fissures, fistulas, perforated colon, and bowel obstruction. It’s estimated by the Centers for Disease Control and Prevention that 3.1 million people in the United States have IBD, according to surveys done in 2015. Corticosteroids are a treatment often used to cause a reduction in the inflammation that is a result of IBD. The issue with this though is that other areas of the immune system that are essential to repairing damaged tissue are sometimes impeded. This is because immune cells known as macrophages work to cause inflammation but also work in repair processes. Macrophages are a type of white blood cell that encompass and kill microorganisms, eliminate dead cells, and stimulate other immune system cells in action. So while they can get rid of cellular debris and microorganisms, they can also release signaling molecules that begin the inflammatory or repair processes. But this molecular mechanism that allows them to switch from inflammatory mode to repair mode has remained unknown, till now. Sufferers of now have something to possibly look forward to. A 2020 research paper published in “Gut” medical journal believes they have discovered this “master switch” inside the body that can initiate healing within the intestinal tract. Researchers out of Seoul National University College of Medicine looked at humans and mice that developed IBD. They started by looking at macrophages within the intestines of human participants who were currently having a flare-up. The researchers discovered that the IBD sufferers had lower numbers of one specific kind of macrophage in their gut, in comparison to those who don’t have IBD. But when the flare-up was over, the number of these particular macrophages increased. Due to this, it was believed apparent that these macrophages have a role within the reparative process. These cells also had receptors within their cell membrane for a molecule named prostaglandin E2, or PGE2. This is a hormone-like signaling molecule, that is known to be associated with tissue regeneration. During the second part of the study, the researchers looked at the mouse equivalent of the aforementioned macrophages. Again, the mice had ulcerative colitis, which is one kind of IBD. This uncovered that the cells with PGE2 receptors were not very prevalent in the animals with IBD. But when the researchers increased PGE2 levels within the animals’ guts, they released a substance that contributes to tissue regeneration. The substance is abbreviated to CXCL1, with the scientific name being chemokine (C-X-C motif) ligand 1. To test their theory that PGE2 receptors are behind the macrophages’ ability to switch from inflammatory mode to healing mode, the scientists engineered mice whose bodies couldn’t produce the receptor. Their hypothesis in this particular case ended up being true, and these particular mice had a hard time attempting to repair the cells lining their gut. Then the researchers dispensed a drug that stimulated the cells into making CXCL1, thereby reinstating the macrophages’ potential to heal. They were able to deliver this drug to the mice through liposomes that were ingested by the macrophages. Liposomes are spherical small fluid filled sacs that are formed artificially to carry drugs or substances into cell tissues. Since this is all a newly released study, and new information regarding macrophages and their role within inflammatory bowel disorders, much more research will have to be completed before this information can assist current day sufferers. Regardless, this is a positive turn of events for the scientific and medical community. Author: Angelica Trpkovski
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Growing tomatoes in hawaii

Tomatoes can be difficult to grow in Hawaii, but if you follow these steps you can look forward to tomatoes much tastier and vibrant than what you find in supermarkets. You can grow tomatoes all year round in Hawaii thanks to our warm, generally sunny climate. Tomato plants need 6 to 8 hours of direct sunlight a day and do not like wet or humid conditions. Some important tips to keep in mind: Tomatoes are 95% water, 3% carbohydrates, 1% protein, and 1% fat along with vitamins A, B, and C and minerals like calcium, magnesium, potassium, and zinc. They also contain a unique antioxidant called lycopene, which is what gives tomatoes their brilliant red color. Some research has shown lycopene can lower cholesterol levels and blood pressure (Cheng, 2017; Salehi, 2019), so eating tomatoes may benefit you in more ways than one! Research evidence also shows eating cooked tomatoes or tomato products with olive oil or other healthy fats increases the amount of lycopene absorbed (Friedman, 2013). Local favorites like spaghetti or chili would take advantage of this benefit! Avoid eating tomatoes if you have certain medical conditions like:  Have you grown tomatoes in your yard?  What kind of tomatoes have you grown? Having problems growing tomatoes? Share them here so we can help you troubleshoot and find a solution. What dishes or cuisines that use tomatoes do you enjoy?
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The Dreaded Pelvic Exam

<b>Do I really need one every year?</b> The pelvic exam can be one of the most dreaded procedures that many people experience. I remember my first one very clearly. I guess I was lucky because thankfully, everything went well. But luck doesn’t happen on its own for most of us. There’s usually some sort of reason behind a good result.&nbsp; I believe the main reason why my pelvic examination experience was positive is because I trusted my provider and she explained exactly what to expect in a comfortable and open way. She also gave me a few tips and tricks to help make the whole thing as easy as possible, which I’ll cover later, so keep reading! So let’s start off with the bigger picture.&nbsp; <b>What is a pelvic exam?</b> A pelvic examination is a comprehensive term used to describe a physical examination of the uro-gynecological body parts. Basically, everything between the belly button and groin. It is made up of a few sections: Visual exam, speculum exam, Pap smear, and manual exam.&nbsp; <b>Why are pelvic exams important?</b> As much as medicine has evolved and improved over decades, we still have not figured out an easier way to thoroughly and safely assess this part of the body. No scans or blood tests can substitute for a pelvic exam, unfortunately. I’m sure whoever figures out a substitute will make A LOT of money. <b>When do I get a pelvic exam?</b> For most women, pelvic exams occur during well-woman visits. This visit allows a women’s health provider to cover all of the necessary screenings and treatments of obstetric or gynecological concerns. Unfortunately there is a stigma of well-women visits due to uncomfortable discussion and patients may have a lot of unanswered questions without knowing how to express them.&nbsp; In my family, our Asian culture dictates that young women don’t need a well-woman visit unless they are pregnant or there is something drastically wrong with their reproductive system. So I was discouraged to see a women’s health provider, which was unfortunate but continues to be a reality for many young women. For those who do have the privilege of accessing to a women’s health provider, a well-women visit is a great opportunity to ask questions, gain knowledge, and feel more confident in their body. Some other topics and questions that are commonly discussed during a well-woman visit include planning for pregnancy, vaginal discharge, sexually transmitted illnesses, pain related to intercourse, mood swings with menstrual period, and even history of trauma. A well-woman exam is a perfect and safe time to bring to light personal questions regarding topics such as these. Your provider should be able to address your concerns in a way that is open and nonjudgmental. However, that brings us back to one of the most infamous parts of a well-woman exam. The dreaded pelvic exam. <b>Wherein lies the last question - Do women really need a pelvic exam every year?</b> The most closely followed recommendation comes from the American College of Obstetricians and Gynecologists (ACOG). Their guidelines state: Other society recommendations include United States Preventive Services Task Force (USPSTF), American College of Physicians (ACP), American Academy of Family Physicians (AAFP). They agree that there is insufficient evidence to do screening pelvic exams for asymptomatic and nonpregnant women unless there is evidence for a health or cancer screening concern.&nbsp; Other symptoms that might clue a provider into recommending a pelvic examination include: So it is important to have a discussion with your provider and decide whether a screening pelvic exam is appropriate for you. Everyone is in a different stage of life and health. One of my close friends declined to have a pelvic examination until she was 33 years old because of personal and religious reasons. She had a thorough discussion with her provider and they came to a decision together to hold off until a more appropriate time, which was completely fine for her situation. The consensus is clear - NO you do not necessarily need an annual pelvic exam. But it is crucial to discuss this with your provider! <b>If it is appropriate for you to undergo a pelvic exam, here are some tried and true tips to help prepare for a (relatively) easy experience:</b> <b>Relaxation is key.</b> If your muscles are tense, the examination is going to be more uncomfortable. Being mentally present and relaxing the pelvic muscles will make your experience tenfold more tolerable. Identify the muscles that you use to hold your bladder and relax them one by one until all the tension disappears. Don’t forget to breathe.&nbsp; <b>How to prepare.</b> For the most accurate exam and to avoid any false test results, the best recommendation is to avoid vaginal intercourse, douching, or inserting anything into the vagina within 24 hours before your exam. <b>Don’t worry about what you look like!</b> Having someone who is basically a stranger look at you down there can make anyone feel self-conscious. Your provider has been trained on how to approach this type of appointment and what they see is never based on cosmetic standards. They are looking for strictly anatomical abnormalities and know which steps to take next if anything is identified. <b>Your provider won’t do anything you don’t want to.</b> Ultimately, your health is in your hands. Say for example, you go into a well-woman exam and decide with your provider to start a pelvic examination. If, halfway through the exam, you start feeling very uncomfortable, then the provider will do their best to address those concerns immediately.&nbsp; <b>Confidentiality.</b> This is above all! Nothing that is shared leaves the examination room, unless it is with your consent.&nbsp; So to sum things up, a pelvic exam is a common discomfort in most women’s lives, but there are many reasons for its necessity. And despite its notorious experience, there are ways to prepare beforehand to help improve your experience! Sources: <a href="https://www.aafp.org/afp/2015/0515/p732.html">https://www.aafp.org/afp/2015/0515/p732.html</a> <a href="https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/10/the-utility-of-and-indications-for-routine-pelvic-examination">https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/10/the-utility-of-and-indications-for-routine-pelvic-examination</a>
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Staying Healthy as an Immunocompromised Individual

2020 became the year when the word “immunocompromised” entered everyone’s vocabulary more than ever.&nbsp; As described by Penn Medicine, immunocompromised means that your “immune system’s defenses are low, affecting its ability to fight out illness and infection.”&nbsp; Because of the COVID-19 pandemic, many people became educated of different reasons one could be considered as having a weakened immune system: These including many other factors can increase your susceptibility to illness and infection, including the coronavirus.&nbsp; Our immune system is an intricate network comprised of cells and proteins that work together to stave off infections and protect the body. Many of us remember learning about white blood cells in school and how they work together to fight and defend the body against invading germs, infections and disease.&nbsp; Immunocompromised individuals are not only more prone to sickness and infections but an infected person with a weakened immunity may also experience prolonged or more serious symptoms, especially when compared to an infected individual with a healthy immune system.&nbsp; Even if an individual doesn’t have any of the aforementioned illnesses or conditions, it is possible still to have a weak immune system. One of the tell-tale signs is a predisposition to illness and infection.&nbsp; This could look like: A weak immune system can even lead to a variety of health issues, like autoimmune or blood disorders, digestive issues, and developmental delays in children.&nbsp; Alongside frequently getting sick, or frequently developing infections, another sign of a lowered immunity is when wounds will not heal as quickly as usual. Quick healing burns or cuts are dependent on a healthy immune system.&nbsp; The digestive tract plays a large role in a healthy immune system. A study published in January 2012, in a medical journal entitled Gut Microbes, researchers Hsin-Jung Wu and Erin Wu state that “keeping a delicate balance in the immune system by eliminating invading pathogens, while still maintaining self-tolerance to avoid autoimmunity, is critical for the body’s health.” Therefore another sign that someone may be suffering from lowered immunity can be if they exhibit many digestive issues.&nbsp; These can manifest as chronic diarrhea, constipation or gassiness. Without the correct amount of gut bacteria, one may become vulnerable to viruses, chronic inflammation of the intestinal tract, or in extreme cases, autoimmune disorders.&nbsp; Mental health can also affect one’s immunity. This is because stress lowers the number of lymphocytes in the body. Lymphocytes are the white blood cells that battle infection from within. The American Psychological Association, or the APA, has compiled a series of studies that reflect ways in which periods of high stress can weaken the immune system. Findings from numerous studies have shown periods of depression, loneliness or stress can all lower your immunity. They found long term or chronic stress has a significant ability to negatively affect one’s immunity. The negative effects of stress and depression on an individual’s immune system becomes even more severe when paired with old age. Stress can also lead to a lower energy level or trouble sleeping.&nbsp; Sometimes having trouble sleeping can be another symptom of a weakened immune system. When an individual’s immunity is low, their body attempts to conserve energy in order to properly fight off any viral attackers. This then can leave an immunocompromised individual feeling tired, even if they have had a full night’s sleep.&nbsp; Luckily, there are ways to assist a lowered immunity. During the COVID-19 pandemic, people worldwide learned one of the most important steps. It is also one of the most simple, and that is practicing good hygiene.&nbsp; Washing one’s hands as frequently as possible, and mostly at key moments such as before eating, or after touching garbage, is said to majorly decrease the spread of illness.&nbsp; Disinfecting objects around the home, especially those that are touched more often than others can also reduce the spread of illness by eliminating germs.&nbsp; Another easy method to avoid getting sick is to avoid being around people who are sick. During the coronavirus pandemic, many individuals practiced self-isolation. This is especially recommended for people with a weak immune system, at least until the conditions of the COVID-19 pandemic lessen.&nbsp; Now as COVID-19 vaccines are becoming available, medical experts believe we may be seeing the light at the end of the tunnel, as far as the fear surrounding the coronavirus goes. Doctors highly recommend that everyone stay up to date with all of their vaccinations. This includes the COVID-19 vaccine when it becomes more widely available.&nbsp; It is also recommended if an individual has a very weak immune system that they should be in close contact with their doctor regarding any vaccines, medical advice, or treatment.&nbsp; Although it has been a stressful time for many, stress does far more harm than good when the immune system is involved. Attempting to manage one’s stress is not only advisable for mental health, but also physical health.&nbsp; Here are some ways to do so: Stay aware of what you put into your body, and treat your body well and often your body will treat you well in return. Although there are conditions where regardless of how well an individual takes care of themselves, the immune system will still stay weakened.&nbsp; This is why, more than ever before, it is important to practice good hygiene, eat well, and attempt to stay away from stress.&nbsp; Until COVID-19 is a thing of the past, it is also of course essential to continue practicing social distancing.&nbsp; Remember if you or a loved one seems to have any of the symptoms listed above, to speak to a doctor and get a professional perspective. Especially as these symptoms can not only be a sign of a lowered immunity, but perhaps other medical issues.&nbsp; Stay safe, healthy, happy, and don’t forget to take time to yourself when you need it.&nbsp;
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Electronic Tattoos and their Possible Future in Medicine

Tattoos have grown in popularity over the past few decades, and with that so&nbsp; have humanity’s collective creativity. Electronic tattoos seem like something out of a&nbsp; futuristic movie or video game but they have actually been around since the late 2000s, and are continuously improving. The concept of printing electronic devices onto human&nbsp; skin was invented by John A. Rogers at the University of Illinois. These tattoos are&nbsp; different from regular tattoos, where ink is repeatedly injected into the skin. Instead,&nbsp; think of it more like a wearable chip. John A. Roger’s initial version was a thin film that&nbsp; would be applied to the skin much like a temporary tattoo, and would contain sensors to&nbsp; monitor different bodily responses. In 2017, the electronic tattoo was made even more comfortable, when researchers out&nbsp; of Waseda University expanded upon the original design by making it thinner and more&nbsp; flexible. They were able to connect electronic parts together without the use of&nbsp; soldering, and instead by using inkjet printing. Then to attach the tattoo to the skin, no&nbsp; adhesive matter is necessary, they are simply rubbed on the skin. The most recent development in the area of electronic tattoos was revealed the 13th of&nbsp; January, 2021. A team of researchers out of China published their revolutionary&nbsp; reiteration that shows just how fast approaching this technology is. It was constructed as&nbsp; extremely flexible, able to repeatedly stretch and move with the skin. The researchers&nbsp; invented an electronic tattoo that was triple layered, with 15 sensors that were able to&nbsp; monitor the movement of the hand it was applied upon. The electronic tattoo was also&nbsp; able to remotely control a robot hand. Unlike implanted electronic chips, which are a surgical procedure, electronic tattoos are&nbsp; designed to be much more comfortable and less drastic. There will be no risk of the&nbsp; body rejecting the tattoo like there is with an implant. What is great about this newest&nbsp; development is it will be able to stay for a longer amount of time on the human skin&nbsp; without needing a replacement or reattachment. It is believed this technology will&nbsp; inevitability replace objects like smart watches and other wearable devices in the not-so far future. The most exciting prospect of electronic tattoos is their eventual application in the field&nbsp; of medicine. These tattoos could have a variety of bodily functions that could be&nbsp; monitored, depending on the individual and their specific needs. Ideally, an electronic&nbsp; tattoo would be able to monitor a patients vital signs 24 hours a day, and would stay on&nbsp; for long periods of time. In cases of a medical emergency, the tattoo’s connect-ability to&nbsp; the web would also allow it to alert emergency response services. Maybe even in the&nbsp; same moment of this alert, the tattoo would transmit necessary data about the patient’s&nbsp; condition. There have been small examples of this. In 2016, a company called MC10 developed&nbsp; the Biostamp. It’s a waterproof, rechargeable, and re-wearable sensor, that looks similar&nbsp; to a band-aid. It’s thicker than the aforementioned examples of electronic tattoos but is still an excellent example of how this technology could be easily applied to the world of&nbsp; medicine. It is able to monitor your vital signs, bodily activity, posture, and sleep habits,&nbsp; along with their relationships to each other. Everything received by the sensor is then&nbsp; portrayed in an app, as well as a web portal, and it has already been used in a few&nbsp; studies as an alternative to wires. Nanoengineers out of the University of California back in 2015 actually invented an&nbsp; electronic temporary tattoo that was claimed to be able to extract and measure glucose&nbsp; levels without the use of needles. Like the previous electronic tattoos, this device&nbsp; contained electrodes, but unlike prior examples, these electrodes were printed on&nbsp; temporary tattoo paper. Unfortunately, a 2018 clinical trail meant to test the&nbsp; effectiveness of this technology was canceled and has yet to be restarted. In cases like the glucose monitoring temporary tattoo, there is further to go when it&nbsp; comes to the development of electronic or digital tattoos. But as is evidenced in the&nbsp; most recent example, the triple layer tattoo developed in China, “smart” tattoos&nbsp; becoming a daily part of our reality is not as far away in the future as one might think. Author: Angelica Trpkovski
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dIABETES AND THE HUMAN GUT MICROBIOME

Type 2 diabetes is a serious metabolic condition that affects more than 34 million,&nbsp; roughly one in 10 Americans, ranking as the seventh leading cause of death in the entire&nbsp; nation. Type 2 diabetes occurs when the body either becomes resistant to insulin, or when the&nbsp; pancreas becomes unable to produce enough insulin. Insulin is a hormone that is produced by&nbsp; the pancreas, producing and discharging insulin into the bloodstream. This insulin then&nbsp; circulates throughout the bloodstream, allowing sugar to then enter your cells. Glucose, which&nbsp; is a sugar, is important because it is a main source of energy for the cells that make up our&nbsp; muscles and other body tissues. Your liver stores and produces this glucose, and with the help&nbsp; of insulin, sugar is absorbed into the bloodstream.&nbsp;&nbsp; The issue with type 2 diabetes is that this process is flawed. So instead of sugar being&nbsp; absorbed into the body’s cells, it builds up within the bloodstream. Then, as these blood sugar&nbsp; levels increase, the pancreas creates and releases more insulin, but eventually cannot produce&nbsp; enough to comply with the body’s demands. So for some individuals, their body either resists&nbsp; the effects of insulin or their pancreas is unable to produce enough insulin to maintain normal&nbsp; glucose levels within the bloodstream. This is a bit different to type 1 diabetes, which is less&nbsp; common. As far as the causes of diabetes 2, genetics are largely to blame, along with&nbsp; environmental triggers, which include being overweight and/or inactive. A diet rich in saturated&nbsp; fats, refined sugars, and alcohol all have also been linked to the increase in cases of type 2&nbsp; diabetes.&nbsp;&nbsp; Very recently, new information has come out pertaining to a possibly ground-breaking&nbsp; treatment, or even hinting at a cure to the growing pandemic that is diabetes 2. In January of&nbsp; 2021, researchers from Oregon State University released a study that claims to have potentially&nbsp; discovered a link between select organisms in the gut micro-biome and the role they play in&nbsp; type 2 diabetes. A micro-biome is defined as the microorganisms in a particular environment,&nbsp; and in this case the human gut micro-biome, which is composed of more than 10 trillion&nbsp; microbial cells made up by over 1,000 different bacterial species. Part of what this new study&nbsp; focuses on imbalances within the gut micro-biome and how they can have a negative effect on&nbsp; someone’s health. These imbalances are referred to as dysbiosis often within the study.&nbsp; Dysbiosis is said to be the result of complex changes that result from the&nbsp; aforementioned microbes and their interactions. This most recent study infers that certain&nbsp; members of the microbial community, when altered by a specific microbial focused diet, could&nbsp; have a positive effect on the host. In particularly, the study focused on microbes that would&nbsp; affect the way an individual can metabolize glucose and lipids, which as we learned before,&nbsp; can directly link to sufferers of diabetes type 2. In their study, they focused on a western diet,&nbsp; finding links between certain microbes existing within the human gut micro-biome and obesity.&nbsp; This led to the discovery of four different bacteria that effect the ability to metabolize glucose.&nbsp; Two of the four discovered were thought to improve glucose metabolism, while the other two&nbsp; are thought to worsen one’s glucose metabolism.&nbsp;&nbsp; Through studies carried out on mice, the scientists found links between the improving&nbsp; bacteria and a lower BMI, with the other bacteria had correlations to a higher BMI within the&nbsp; test mice. As scientists, doctors and researchers learn more about the bacteria identified in the&nbsp; study (Lactobacillus johnsonii, Lactobacillus gasseri, Romboutsia ilealis and Ruminococcus&nbsp; gnavus,) and how they interact with obesity, society will be able to develop new treatments for&nbsp; both growing epidemics. Since this is a relatively new discovery, it may be a little while until a&nbsp; new treatment is fully unearthed, but regardless, this is a very positive step in the right direction&nbsp; for sufferers of diabetes, especially those in America who may indulge in a high fat diet. Author: Angelica Trpkovski

Our Care Providers

Angel Borges
Angel Borges
Medical Assistant
No Overview Provided

Michael Quay
Michael Quay
Mental Health Counselor
My name is Michael Quay. I graduated from Georgia State University with a M.S. in Rehabilitation Counseling in 1991. Initially, I worked with private sector workers’ compensation cases (primarily back injuries) then I was able to progress to serving as the Crisis Intervention Coordinator for a Public Mental Health Center. Here I coordinated the center’s emergency services which included consults to local jails & hospitals to evaluate primarily depression and suicide. In addition, I carried a caseload of 35-40 adults with a variety of mental health diagnoses. Over the years I developed an ability to work with borderline personality disorders due to their high frequency of using the center’s emergency line. After five years I moved on to serve as the clinical coordinator for a hospital based geriatric psychiatric day treatment program. Most of the clients were 65-90 and suffered depression and anxiety. The next two years I had the privilege of serving as the Children’s Pastor (Birth to 5th Grade) for a church with a Sunday attendance of about 1500. Over the next year I was ministering in Angeles City, Philippines as a missionary working with local church children’s workers. Finally, from 2003-2012 I had the honor to work as a School Based Behavioral Specialist (SBBH now SBS) working for the Hawaii Department of Education at three High/Intermediate Schools in East Hawaii. Most of my clients were Special Education, Oppositional-Defiant with A.D.D. My caseload was almost exclusively male & these were my favorite clients of all. I was a Certified Rehabilitation Counselor (C.R.C.) from 1991 to 2001. Also I was a Nationally Certified Counselor (N.C.C.) from 1996 to 2004. Those same years (1996-2004); I was a Licensed Professional Counselor (L.P.C.) in the State of Alabama. Recently, I became a Licensed Mental Health Counselor (L.M.H.C.) in the State of Hawaii. Among my interests professionally are depression, anxiety, A.D.D./Defiant Teens (especially males), families who have end of life issues with parents, marital counseling, & life care planning (not estate planning BUT working out your life plan). I am more of a person-centered therapist who believes YOU are the expert on your life. I do cognitive-behavioral mostly with teens & children. In addition to my years as a mental health professional, I am a U.S. Army Captain, Retired; who had the honor to go to Airborne School.

Marisa Takiguchi
Marisa Takiguchi
Nurse Practitioner
Marisa was born and raised here in Honolulu, HI. She is a board-certified Family Nurse Practitioner. She attended the University of Hawaii at Manoa and obtained both her Bachelor's of Science in Nursing degree and her Doctorate of Nursing Practice degree. In her spare time, she enjoys spending time with family, friends and her maltese.

Paige Turner
Paige Turner
UH
"A Building With Four Walls And Tomorrow Inside"

Pamela Finch
Pamela Finch
Medical Assistant
"Make life beautiful" -- Shea McGee

Mark Causin
Mark Causin
Physician
If the path be beautiful, let us not ask where it leads

Chris Apostolides
Chris Apostolides
Physician Assistant
Your body is your most priceless possession...so go take care of it! Physician Assistant practicing Emergency Medicine for over 15 years. Masters of Science from Towson University, 2005. Certified by National Commission on Certification of Physician assistants since 2005.

Christina Robbins
Christina Robbins
Physician Assistant
Butterflies can't see their wings.

Isaiah Mallari
Isaiah Mallari
Nurse Practitioner
As a board certified Family Nurse Practitioner, Isaiah is both diligent in his practice and his passion of giving back to others. Isaiah received his Master of Science in Nursing from Hawaii Pacific University. Prior to joining NIU health as a provider, he worked in a number of critical care settings for the past 7 years and became a Certified Critical Care Registered Nurse. Having witnessed his father pass away at such a young age in the intensive care unit, it drove him to serving to this capacity. In his free time, he enjoys surfing, CrossFit, yoga, and trying out new restaurants.

Paul Coelho
Paul Coelho
Chief Nurse Executive
Dr. Paul Coelho was born and raised on the Island of Oahu. He received his Masters of Science in Nursing from the University of Hawaii at Manoa, and later obtained his Doctors of Nursing Practice from Hawaii Pacific University. He is board-certified as a Clinical Nurse Specialist by the American Nurses Credentialing Center. Paul is licensed as an Advanced Practice Registered Nurse with prescriptive authority in Hawaii. His medical specialties of interest and expertise include cardiology, HIV/AIDS care management & prevention, urgent care, and nurse management & leadership. Paul believes that NIU Health will provide him a platform to continue his passion for nursing practice and his dedication to improving the health and well being of the people of Hawaii. Paul considers a work-play balance important to maintain optimal physical and mental health, therefore, he enjoys hiking, running, surfing, playing tennis, and yoga.

Danine Dela Cruz
Danine Dela Cruz
Medical Assistant
Beauty begins the moment you decide to be yourself

Maricel Mercado
Maricel Mercado
Medical Assistant
Be your own kind of beautiful

Dr Tony Trpkovski
Dr Tony Trpkovski
CEO and Founder of NIU Health
Co-founder / CEO Doctors of Waikiki Board Certified Internal Medicine Best of USA-Best Physician 2016 Best of Kauai –Best Physician 2010-2011 Wright State University June 1994 to June 1997 Internship and Chief resident in Internal Medicine Miami Valley Hospital, Dayton Ohio “Sts Cyril and Methodius” Medical School Hospital Feb 1993 to Feb 1994 Internship General Medicine, Skopje, North Macedonia University of Sts Cyril and Methodius, School of Medicine Graduated Jan 1993 Skopje, North Macedonia Republic of North Macedonia: full scholarship faculty of medicine 1984-1993 “Always laugh when you can, it is cheap medicine.”

Alexis Barroga
Alexis Barroga
Nurse Practitioner
Alexis has always had a passion to help people and that’s why she pursued a career in Nursing. After earning her Bachelor of Science in Nursing at the University of South Alabama, she worked in a Surgical Trauma Intensive Care Unit in a Level 1 Trauma Center. It was a great learning experience but she was eager to learn more about patient care outside of the hospital setting. She became a Certified Family Nurse Practitioner because she wanted the opportunity to build rapport and play an active role in the overall health of her patients, ensuring they receive the right treatment and care to live long healthy lives. Alexis is beyond excited to join NIU Health and provide quality and cost-effective health care to her Hawaii Ohana. Her in-laws (grandma, parents, sisters, aunties, uncles, nephews, nieces, cousins) all live on island so she understands firsthand how difficult and expensive health care is. She believe’s this is something that has been missing from the healthcare system and she feel’s so blessed to be able to be a part of it.

Kasey Kam
Kasey Kam
Nurse Practitioner
Kasey is an Adult-Gerontology Primary Care Nurse Practitioner who first found his passion for healthcare while caregiving for his late father and grandparents. He went on to work at Straub Medical Center and a national nursing agency where he enjoyed working with the young and elderly alike. He is excited to be part of the NIU Health team because of the unique ways he’ll get to engage patients. He received his Doctor of Nursing Practice from the University of Hawaii at Manoa. In his downtime, he enjoys cooking Japanese, Italian, and local-style foods. Tomato gardening is his new favorite hobby.

Jamie Noguchi
Jamie Noguchi
Nurse Practitioner
Jamie has called O'ahu her home since the beginning, born and raised here on the island. She attended University of Hawai'i at Manoa for both her undergraduate and graduate degrees, completing UH Manoa's accelerated nursing program to become an Adult-Geriatric Nurse Practitioner. Due to being very close with her grandparents and witnessing their later years of life, her career experience has been focused largely in neurology and primary care, with a special interest in the ever-developing field of dementia and cognitive impairment. She especially enjoys building lifelong relationships with her patients, and seeing families grow over the years with thriving health. She is very excited to join NIU HEALTH because of its fresh take on providing quality, consistent healthcare to everyone. Its philosophy looks toward the future, is fair and affordable, and presents a solution that works for all types of socioeconomic situations. And now more than ever, that is exactly what the world needs.

Amanda Buzynski
Amanda Buzynski
Nurse Practitioner
Amanda Y. Buzynski, FNP-BC, APRN-RX, SAFE is a Queens, NY Native. She is a Family Nurse Practitioner and a Forensic Examiner. In 2019, Amanda received her Master of Science as a Family Nurse Practitioner from D’Youville College in Buffalo, NY. She has gained seven years of experience at the Erie County Medical Center emergency department; a level 1 Trauma Center. Currently, she works on the island of Oahu, in the emergency department at Queens Medical Center. Amanda has spent the last few years as a “Stop the Bleed” instructor and has taught the life-saving educational program at schools, community events, and even brought the training to rural Sierra Leone during a medical mission trip. Her hobbies include travelling, learning about new cultures, and learning how to cook the cuisine from the countries she visits. She has a special interest in nutrition as an adjunct therapy for many chronic diseases. Amanda believes that access to healthcare is a human right, and that NIU health is a revolutionary way to expand access to healthcare to the people of Hawaii. She is very excited to be a part of the next phase of healthcare with NIU Health.